The net effect is a reduction in cardiac efficiency[40] at rest that may predispose to diabetic cardiomyopathy[41-43], but that also causes increases the susceptibility of the insulin resistant heart to myocardial ischemia and to a greater reduction in myocardial performance for a given amount of ischemia compared with the normal heart[44-46]. This evidence concerns the gene INS and myocardial ischemia.